Associations of Retinal Microvascular Diameters and Tortuosity With Blood Pressure and Arterial Stiffness: United Kingdom Biobank

Robyn J Tapp, Christopher G Owen, Sarah A Barman, Roshan A Welikala, Paul J Foster, Peter H Whincup, David P Strachan, Alicja R Rudnicka

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42 Citations (Scopus)
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To examine the baseline associations of retinal vessel morphometry with blood pressure (BP) and arterial stiffness in United Kingdom Biobank. The United Kingdom Biobank included 68 550 participants aged 40 to 69 years who underwent nonmydriatic retinal imaging, BP, and arterial stiffness index assessment. A fully automated image analysis program (QUARTZ [Quantitative Analysis of Retinal Vessel Topology and Size]) provided measures of retinal vessel diameter and tortuosity. The associations between retinal vessel morphology and cardiovascular disease risk factors/outcomes were examined using multilevel linear regression to provide absolute differences in vessel diameter and percentage differences in tortuosity (allowing within person clustering), adjusted for age, sex, ethnicity, clinic, body mass index, smoking, and deprivation index. Greater arteriolar tortuosity was associated with higher systolic BP (relative increase, 1.2%; 95% CI, 0.9; 1.4% per 10 mmHg), higher mean arterial pressure, 1.3%; 0.9, 1.7% per 10 mmHg, and higher pulse pressure (PP, 1.8%; 1.4; 2.2% per 10 mmHg). Narrower arterioles were associated with higher systolic BP (-0.9 µm; -0.94, -0.87 µm per 10 mmHg), mean arterial pressure (-1.5 µm; -1.5, -1.5 µm per 10 mmHg), PP (-0.7 µm; -0.8, -0.7 µm per 10 mmHg), and arterial stiffness index (-0.12 µm; -0.14, -0.09 µm per ms/m2). Associations were in the same direction but marginally weaker for venular tortuosity and diameter. This study assessing the retinal microvasculature at scale has shown clear associations between retinal vessel morphometry, BP, and arterial stiffness index. These observations further our understanding of the preclinical disease processes and interplay between microvascular and macrovascular disease.

Original languageEnglish
Pages (from-to)1383-1390
Number of pages8
Issue number6
Early online date30 Oct 2019
Publication statusPublished - Dec 2019
Externally publishedYes

Bibliographical note

© 2019 The Authors. Hypertension is published on behalf of the American Heart Association, Inc., by Wolters Kluwer Health, Inc. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution, and reproduction in any medium, provided that the original work is properly cited.


  • Adult
  • Aged
  • Biological Specimen Banks
  • Blood Pressure Determination/methods
  • Cardiovascular Diseases/epidemiology
  • Cohort Studies
  • Comorbidity
  • Female
  • Humans
  • Hypertension/diagnosis
  • Hypertensive Retinopathy/diagnostic imaging
  • Incidence
  • Male
  • Microvessels/physiology
  • Middle Aged
  • Retinal Vessels/physiopathology
  • Retinoscopy/methods
  • Retrospective Studies
  • Risk Assessment
  • Vascular Stiffness/physiology


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